Tex.
Ins. Code Section 1272.152
General Reserve Requirements
(a)
A delegated network shall maintain reserves adequate for the liabilities and risks assumed by the network, as computed in accordance with accepted standards, practices, and procedures relating to the liabilities and risks for which the reserves are maintained, including known and unknown components and anticipated expenses of providing benefits or services.(b)
Except as provided by Sections 1272.153 (Reserve Requirements for Medical Care and Hospital or Institutional Services) and 1272.154 (Reserve Requirements for Prescription Drugs), a delegated network shall maintain reserves as described by Subsection (c) only with respect to the portion of services assumed under the delegation agreement that is outside the scope of the network’s license for medical care or hospital or other institutional services, as applicable.(c)
A delegated network shall maintain financial reserves equal to the greater of:(1)
80 percent of the amount of liabilities and risks for which reserves must be maintained under this subchapter and that have been incurred but not paid by the network; or(2)
an amount equal to two months of the premium amount assumed by the network for services with respect to which reserves must be maintained under this subchapter.
Source:
Section 1272.152 — General Reserve Requirements, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1272.htm#1272.152 (accessed Jun. 5, 2024).
